The index measures the number of people who may not be financially prepared for retirement. The Center for Retirement Research (CRR) at Boston College, which publishes the NRRI with Nationwide, said the addition of long-term care bumps the index from 61% a year ago to about 64%.

According to a news release, the NRRI baseline reading without the health-care impact was 44%, and the 61% figure includes only general health-care expenses.

After adding the expected cost of long-term care insurance and out-of-pocket health care spending in retirement, the target replacement rate jumps to 98%, compared to the original NRRI replacement rate of 76% and the basic health NRRI replacement rate at 92%.

According to the CRR: “As with past NRRI analyses, these latest findings raise major concerns about the retirement security of Baby Boomers and succeeding generations.”

The CRR said long-term care plays a critical role in the retirement of many Americans so it needs to be considered in the overall retirement readiness calculations.

“Long-term care is an important expenditure risk for the elderly,” the CRR said. “People tend to lose some of their ability to function as they get older, and these losses can become severe late in life. To compensate, older people need assistance with basic activities of daily living (such as bathing, eating, dressing, and using the toilet) and with tasks necessary for independent living (such as shopping, cooking, and housework).”

The NRRI is updated twice annually. The latest report is available here.